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Images in Neurology
January 1999

"Toilet Seat" Sciatic Neuropathy

Arch Neurol. 1999;56(1):116. doi:10.1001/archneur.56.1.116

A 41-YEAR-OLD alcoholic man fell asleep sitting on a toilet seat after drinking heavily and taking oral benzodiazepines. When he awoke a few hours later, he felt his buttocks stuck inside the opening of the seat. He was able to pull himself out, but as he tried to stand up, his left leg gave way, he fell onto the bathroom floor, and he was unable to get up for the remainder of the night. His roommate found him in the morning and called for an ambulance. He complained of low back pain, left buttock pain, and left leg numbness and weakness. The left hamstring, anterior tibial, and gastrocnemius muscles were markedly weak (0-1/5). The left glutei, iliopsoas, hip adductors, and quadriceps muscles were normal. He was numb to pinprick over the entire left foot and lateral calf. Sensation was normal over the left thigh and saddle area. The left ankle reflex was absent, but the knee jerk and plantar responses were normal. There were no petechiae or ecchymoses over the buttocks. His serum creatine kinase level was elevated at 42,000 U/L, and he had myoglobinuria. Computed tomographic imaging of his pelvis (Figure 1) was suggestive of gluteal compartment syndrome. He refused electrodiagnostic studies. He was managed conservatively, subsequently failed to follow up after discharge, but was finally readmitted 4 months later because of head trauma sustained as a result of alcohol intoxication. There had been little recovery of neurologic function to the left leg at that time. Sciatic neuropathy is a recognized complication of gluteal compartment syndrome,1 and similar cases have been reported as "Saturday night palsy" from toilet seat entrapment.2

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